Planned, motivated and habitual hygiene behaviour: an eleven country review

Abstract

Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‘habits’ were generally not inculcated at an early age. Key ‘motivations’ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. ‘Plans’ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study.

Handwashing behaviour among Chinese adults: a cross-sectional study in five provinces

“…However, many studies have moved away from the simple assumption that knowledge about germs and diseases can change or affect attitudes and behaviours. 9 The Theory of Planned Behaviour 25 or extension theory 16 including cognitive and environmental factors were used, and motivation was the focus of the behaviour discussion in these studies. This model is more comprehensive in explaining behaviour formation and change, which could be the direction of future research and studies.…”

“…A survey 9 undertaken by the Global PublicePrivate Partnership for Handwashing in five Sub-Saharan African countries indicated that only 17% of children's caregivers washed their hands with soap after defaecation. In rural Shaanxi province, Zhao et al 10 reported that 40.0% of residents washed their hands before eating and 19.2% did so after toilet use.…”

Risk Factors for Diarrhea in Children Under Five Years of Age Residing in Peri-urban Communities in Cochabamba, Bolivia

“…However, it is also important to mention the extensive literature that exists showing that knowledge alone is often not sufficient to change behavior and that contextual, psychosocial, and technological factors all play a role in facilitating water, sanitation, and hygiene behavior change. [32][33][34][35][36] Effective interventions to target previously identified knowledge and behavioral risk factors for diarrheal disease in children include promotion of hand washing with soap, hygiene education, latrine installation at the household and community level, municipal water connection, water kiosk, householdbased chlorination, filtration, solar disinfection, and improved water storage. [37][38][39][40] However, risk factors for childhood diarrhea vary by population with some factors being more important than others in particular settings.…”

Theory and Practice of Social Norms Interventions: Eight Common Pitfalls

“…Influence of norms has been demonstrated empirically. Drawing on Cialdini's definitions, researchers have demonstrated the influence of social norms on several health-related practices, including: alcohol consumption [45,46], food intake [47], use of recreational drugs [48,49], smoking [50], water purification [51], and hand washing [52].…”